Physiotherapy Case Note Discussions

It is often the case that the effectiveness of your treatment is a combined effort by our entire team. In this article I wish to share a brief insight in the amazing value of collaboration between healthcare professionals.

Starting with a coffee

Every Monday Katie, Paula, Lorraine and myself sit down to a cup of coffee (and often a treat from the Good Food Shop just next door to the clinic) for a team meeting.

We usually start by running through any household or general administration matters which may need discussing. This ensures the smooth running of the clinic and brings us all up to speed with any changes or advances in what we are doing to deliver our Physiotherapy service. Its essential we are all on the same page and to be consistency amongst us in terms of how we do what we do. It is also a great platform for feedback between team members which provides further opportunity for refinement and improvement our internal systems.

Service improvement example

Our Pilates service for example has undergone much tweaking over the year to try and streamline the large amount of administration that goes into running up to 8 classes per week. This has made Katie, one of our Pilates instructors and coordinator of the service, a lot less frantic in the run up to a new term with a significant reduction in her caffeine intake! We hope our valued clients also notice the improvements and ease of use of our new online registration and payment system through our website.

Client case note review

Next on the agenda are case note reviews which run as an open forum type opportunity for each team member to confidentially raise and discuss challenging client conditions. For example, if one of us is treating a client whose pain is not settling or function not improving as quickly as we would like, this in an opportunity to openly discuss the case and benefit from feedback and advice from other team members.

In this way we are able to benefit from a combined 35 years of clinical experience as well as a variety of top class educational backgrounds for the benefit of our clients. These case note review sessions have been fundamental over the years in helping us be highly effective in managing the the vast majority of sometimes complex musculoskeletal pain problems we face, even if this means an onward referral at times.

Example case note discussion - need for a shoe orthotic

An example of a recent case discussion centred around a client with chronic low back pain which after 2 sessions was slow to respond to manual therapy and exercise based treatment. A careful review of the client's detailed case notes revealed a possible biomechanical issue which needed addressing. With Lorraine’s expert input in this area the issue was identified following a lower limb assessment and the client fitted with a pair of prescription orthotics to correct an over-pronating ankle/foot and leg length discrepancy which was resulting in excessive mechanical loading about the low back and pelvis.

The result was almost immediate and with two more sessions of Physiotherapy the client was successfully discharged with a self-management programme.

Example case note discussion - neck pain trigger points

A similar example arose when a client with neck pain did not feel appropriate relief after a session of physiotherapy and the range of movement had not improved as expected. During discussion of the condition along with further review of the case notes, Simon suggested assessing a particular neck muscle for possible myofascial trigger points which may be contributing to the pain and restricted movement. Indeed at the client's next session, trigger points were found, gently treated using a dry needling technique, with an immediate reduction in pain as well as an improvement in function soon following.

Conclusion

Treating musculoskeletal pain can be complex and there is no single approach or magic formula. Often it is a combined approach through trial and error which leads to a successful outcome for the client, as is so often the case in all aspects of medicine. The more communicative we can be in sharing our expertise and experiences, the better service we can provide for our clients.

A further benefit of these team meetings which include the case note reviews, is that Lorraine and I as clinic owners feel very engaged and involved with the goings on in the clinic. I have worked in many clinics where clients come and go, may not be getting better and who 'fall through the net' so to speak by not receiving adequate treatment.

If a client is not responding to treatment or is perhaps unhappy in any way we want to know we have processes in place to ensure the situation is improved as quickly as is possible. Our team meetings and complex case discussions is one of these very effective processes. It is very reassuring to me, as I hope it is to our clients, that our team of experienced medical professionals can regularly share open and productive communications for the primary purpose of managing the welfare of our patients as best we can.

by Simon.